More

Stanford Medicine 25 Blog

Dr. Singh Teaches the Exam of Low Back Pain and Hip Pain

May 13, 2014

At the last Stanford 25 session, Dr. Baldeep Singh taught the exam of low back pain and hip pain. Dr. Singh is the Clinical Chief of the Stanford Internal Medicine Clinic. Below are some take-home points for the session.

When a patient complains of lower back pain, buttock pain, hip pain, etc, the physical exam should focus on the following “zones”:

Ask your patient to undress every time to enhance your exam & look for scars, atrophy, erythema, or rash (i.e. Zoster), and do a thorough neurologic exam in back pain particularly focusing on L4-S1 weakness or numbness (95% of disc diease).

For back pain, gait may help to localize root nerve cause: Direct patient to walk across exam area and back; inability to walk on one’s toes may reflect significant S1 weakness. Inablity to walk on one’s heels may reflect significant weakness L5.